关节置换术后深静脉血栓预防审查指标的制订及障碍因素分析

doi:10.3761/j.issn.0254-1769.2022.24.001

摘要/Abstract

摘要：

目的开展关节置换术后患者深静脉血栓预防的循证护理，制订审查指标，分析循证护理实践过程中的障碍因素及促进因素，制订行动策略。方法以知识转化模式为理论指导，纳入适宜临床情境的关节置换术后患者深静脉血栓预防护理证据24条，制订6条审查标准和33个审查条目，以患者为单位现场观察护士的预防行为，依据基线审查结果采用头脑风暴法分析循证实践中的障碍因素及促进因素，并制订行动策略。结果 6条审查标准的临床依从率为0~100%，其中，护士对患者和（或）照顾者进行预防深静脉血栓形成的健康宣教（0）、护士能正确执行物理预防医嘱（62%）、护士能正确执行药物预防医嘱（81%）、科室开展预防深静脉血栓形成护理方案落实的质量控制（21%）存在改进空间。循证护理实践过程中的障碍因素包括缺乏健康宣教工具和相关流程，护士欠缺相关知识、重视性不足和工作繁忙，以及患者理解力低和参与度低等，促进因素包括组织领导力强、医护团队合作密切、移动护理设备充足、循证科研力量扎实等，据此制订了相应的行动策略。结论该研究基于循证并结合临床专业人员判断制订的审查指标具有科学性、适宜性和可操作性，目前关节置换术后患者深静脉血栓预防证据与临床护理实践存在一定差距，应充分利用促进因素克服障碍，实施改进，促进证据的有效应用。

关键词: 关节成形术，置换, 静脉血栓形成, 循证护理学, 证据审查

Abstract:

Objective To carry out evidence-based nursing for the prevention of deep vein thrombosis（DVT） in patients after joint replacement，to formulate review indicators，to analyze the obstacles and promoting factors in the practice of evidence-based nursing，and to formulate action strategies. Methods Based on the Knowledge to Action framework as the theoretical guidance，a total of 24 pieces of evidence for DVT prevention nursing in patients after joint replacement in suitable clinical situations were included；6 examination criteria and 33 examination indexes were formulated；the preventive behavior of nurses was observed on-site with patients as a unit. Furthermore，based on the results of the baseline review，brainstorming was used to analyze the barriers and facilitators in evidence-based practice，and action strategies were formulated. Results Totally 24 pieces of best evidence were included. According to the best evidence，33 examination indexes and 6 examination criteria were established. The clinical compliance rate of the 6 examination criteria ranges from 0% to 100%. Among them，there is room for improvement in health education（0），mechanical prevention（62%），pharmacological prevention（81%） and quality control（21%）. Obstacle factors include the lack of tools and nursing processes，lack of knowledge，insufficient attention，busy work，as well as low understanding and low participation. Facilitating factors include strong organizational leadership，medical team cooperation，sufficient equipment，etc. Accordingly，corresponding action strategies have been formulated. Conclusion Based on evidence and clinical experience，we formulated the scientific，appropriate and maneuverable indicators. At present，there is a certain gap between the evidence for the prevention of deep vein thrombosis in patients after joint replacement，and we should fully utilize these facilitating factors，overcome obstacles，implement improving measures，and promote the effective application of evidence.

Key words: Arthroplasty，Replacement, Venous Thrombosis, Evidence-Based Nursing, Quality Audit

王钰, 徐园, 邓海波, 王晓杰, 孙建华, 马玉芬, 庞冬, 杨旭, 朱丽筠, 刘佳, 曹海颖, 尚高鹏, 曹晶, 吴欣娟. 关节置换术后深静脉血栓预防审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2022, 57(24): 2949-2956.

WANY Yu, XU Yuan, DENG Haibo, WANG Xiaojie, SUN Jianhua, MA Yufen, PANG Dong, YANG Xu, ZHU Liyun, LIU Jia, CAO Haiying, SHANG Gaopeng, CAO Jing, WU Xinjuan. Evidence application review and obstacle factors analysis for prevention of deep venous thrombosis after joint replacement[J]. Chinese Journal of Nursing, 2022, 57(24): 2949-2956.

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